000			03577nam a22003857a 4500
008			180706s20182018 xxu||||| |||| 00| 0 eng d
022			_a0363-5023
024			_a10.1016/j.jhsa.2018.04.030 [doi]
024			_aS0363-5023(17)30905-X [pii]
040			_aOvid MEDLINE(R)
099			_a29934083
245			_aSelective Thumb Carpometacarpal Joint Denervation for Painful Arthritis: Clinical Outcomes and Cadaveric Study.
251			_aJournal of Hand Surgery - American Volume. 2018 Jun 19
252			_aJ Hand Surg [Am]. 2018 Jun 19
253			_aThe Journal of hand surgery
260			_c2018
260			_fFY2018
266			_d2018-07-06
501			_aAvailable in print through MWHC library: 1999 - 2002, Available online from MWHC library: 1995 - present
520			_aCONCLUSIONS: Selective denervation of the CMC joint is an effective approach to treat pain and alleviate impairment associated with CMC arthritis. The procedure is well tolerated, with faster recovery as compared with trapeziectomy. Branches arising from the lateral antebrachial cutaneous nerve, palmar cutaneous branch of the median nerve, and radial sensory nerve can be identified and resected with a single-incision Wagner approach.
520			_aCopyright (c) 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
520			_aMETHODS: Cadaveric dissections were performed in 10 fresh upper extremities to better define the innervation patterns to the CMC joint and guide the surgical approach for CMC joint denervation. Histologic confirmation of candidate nerves was performed with hematoxylin and eosin staining. Results from a series of 12 patients with symptomatic thumb CMC arthritis who underwent selective denervation were retrospectively evaluated to determine the safety and efficacy of this treatment approach. Differences in preoperative and postoperative measurements of grip and key-pinch strength as well as subjective reporting of symptoms were compared.
520			_aPURPOSE: To determine the innervation pattern to the thumb carpometacarpal (CMC) joint and assess the safety and efficacy of selective joint denervation for the treatment of pain and impairment associated with thumb CMC arthritis.
520			_aRESULTS: Nerve branches to the thumb CMC joint were found to arise from the lateral antebrachial cutaneous nerve (10 of 10 specimens), the palmar cutaneous branch of the median nerve (7 of 10 specimens), and the radial sensory nerve (4 of 10 specimens). With an average follow-up time of 15 months, 11 of 12 patients (92%) reported complete or near-complete relief of pain. Average improvements in grip and lateral key-pinch strength were 4.1 +/- 3.0 kg (18% +/- 12% from baseline) and 1.7 +/- 0.5 kg (37% +/- 11% from baseline), respectively. One patient experienced the onset of new pain consistent with a neuroma that resolved with steroid injection. All patients were released to light activity at 1 week after surgery, and all activity restrictions were lifted by 6 weeks after surgery.
520			_aTYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.
546			_aEnglish
650			_aIN PROCESS -- NOT YET INDEXED
656			_aCurtis National Hand Center
657			_aJournal Article
700			_aHashemi, Shar
700			_aParikh, Pranay
790			_aBroyles JM, Dellon AL, Hashemi S, Lifchez SD, O'Brien-Coon DM, Parikh P, Quan A, Tuffaha SH
856			_uhttps://dx.doi.org/10.1016/j.jhsa.2018.04.030 _zhttps://dx.doi.org/10.1016/j.jhsa.2018.04.030
942			_cART _dArticle
999			_c3498 _d3498